Sacher studied under Felix Weingartner, among others. In 1926 he founded the chamber orchestra Basler Kammerorchester, which specialized in both modern (twentieth-century) and pre-classical (mid-eighteenth-century) repertory. In 1928 he founded the Basel Chamber Choir. Both the orchestra and choir gave their last performance in 1987. In 1984, the Serenata Basel was formed, with no direct connection to Sacher. They later adopted the name Kammerorchester Basel.
Immensely wealthy, Sacher commissioned works from many well-known composers, including:
- Igor Stravinsky (who provided him with the Concerto in D)
- Béla Bartók (Divertimento for Strings, the Sonata for Two Pianos and Percussion, the String Quartet No. 6 and the Music for Strings, Percussion and Celesta)
- Bohuslav Martinů (many works including the Double Concerto for Two String Orchestras, Piano, and Timpani, Concerto da camera etc.)
- Arthur Honegger (many works, including his Second and Fourth Symphonies (Deliciae Basilienses)
- Frank Martin (six works, including the Petite Symphonie Concertante)
- Paul Hindemith
- Hans Werner Henze
- Richard Strauss
- Elliott Carter
- Witold Lutosławski (Sacher Variation, Double Concerto, Chain 2, etc.)
- Henri Dutilleux (3 Strophes sur le Nom de Sacher and Mystère de l'Instant)
- Harrison Birtwistle
Pierre Boulez wrote his Grawemeyer Award-winning work Sur Incises for Sacher's 90th birthday. Boulez bequeathed his entire catalogue (including drafts) to the Paul Sacher Foundation. Henze dedicated his Tenth Symphony to Sacher's memory, who had commissioned it but died before its completion.
In 1983, Sacher acquired the Stravinsky estate. The Paul Sacher Stiftung (Foundation) is located in the center of Basel (in Münsterplatz) and houses one of the world's most important musical-manuscript collections. Sacher bought most of these manuscripts himself, and they include complete collections by several important twentieth-century composers (including Lutosławski, Ligeti and Boulez). In 1997, he received an honorary doctorate from the Academy of Music in Kraków.
He was considered the world's third-richest man of the 1990s after marrying the heiress of the pharmaceutical company Hoffmann-La Roche. At the time of his death, he was reputed in various publications to be the richest man in Europe. He died in 1999, aged 93.
Perhaps his finest recorded performance was preserved on mid-1950s late mono Columbia LP, Johann Christian Bach's Symphony in D major, Op. 18, No. 4, distinguished by its overall serenity, stylishness and smooth flow but also by his taking BOTH repeats (including the second long one, apparently never since taken in later recordings) of the rondo finale quintessentially representative of Johann Christian's serene melding of pre-classical galant (in the opening and closing rondo theme) and sensitive styles (in the canonic middle episode in D minor).